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EXCI 420-A > PPT 7 ET/Depression > Flashcards

PPT 7 ET/Depression Flashcards

1
Q

What is depression?

A

Common and serious illness that negatively affects how you feel, the way you think and how you act

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2
Q

DSM-V criteria for major depression. Main plus 4+ symptoms

A

1- depressed mood and or uninterested in activities
2- symptoms: weight gain or loss, insomnia/hyper, psychomotor retardation/agitation, fatigue, feeling of guilt, reduced concentration, suicidal ideas

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3
Q

% of global annual incidence of MDD

A

3%

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4
Q

Lifetime incidence of MDD

A

15-20%

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5
Q

% of adolescents will have diagnosis of depression by the age of 18

A

11%

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6
Q

Does risk for depression increases with age

A

yes

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7
Q

what is the third leading cause of death among adolescents

A

suicide

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8
Q

is MDD a leading cause of illness and disability across all ages

A

yes

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9
Q

women or men have higher rates of depression

A

women

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10
Q

women 18-24 have x amount higher depression than men

A

3x

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11
Q

is depression more prevalent in people with chronic disease

A

yes

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12
Q

Canada: is ? higher in chronic disease population compared to general population (~5%)

A

two- to threefold

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13
Q

4 categories of non communicable diseases

what is the % worldwide of death and in canada

A

1- cvd
2- diabetes
3- chronic resp disease
4- cancer

  • 70%
  • 64% canada
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14
Q

4 things that cause depression

A

1- inflammation
2- genetic
3- neurochemical
4- life experiences

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15
Q

1- inflammation 4 traits

A

heat
pain
swelling
redness

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16
Q

Individuals living with depression typically tend to exhibit higher OR lower levels of the pro-inflammatory cytokines compared to non-depressed individuals

A

higher

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17
Q

2- Genetics: is there a gene

A

no

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18
Q

3- Neurochemical is what, list 3 NT

A

problems or imbalances in the brain, specifically with the NT:

  • serotonin,
  • norepinephrine,
  • dopamine
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19
Q

4- Life Experiences describe + ex like divorce etc.

A

Major stressful event can contribute to development of depression
Divorce, being bullied, financial difficulties, death of a child or other family member.

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20
Q

2 ways to treat depression

A

1- Pharmacotherapy

2- Psychotherapy- Cognitive-behavioural therapy

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21
Q

Issues with Pharmacotherapy 5

A

1- Individual variability from person-to-person

2-Many side effects (e.g. bleeding, seizure)

3-Low adherence rate

4-Cost of treatment

5-Low perception of effectiveness among patients

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22
Q

Issues with Psychotherapy- Cognitive-behavioural therapy 2

A

1- Accessibility issues

2- Costs

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23
Q

Name some benefits of ET

A 
1- Maintains healthy weight
2- Improves cardiorespiratory capacity
3- Improves sleep
4- Beneficial effects on physical health
5- Improves quality of life
6- Improves + mood
7- Promotes social integration 
8-Increases energy
9-Reduces stress levels
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24
Q

3 benefits on physical health

A

1-Reduces risk of mortality in CVD
2-Reduces dyspnea in COPD/Asthma
3-Improves survival in cancer

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25
Q

Benefits of exercise Regarding depression

4

A

Exercise is related to positive changes in mood state

Less (if none) negative side effects than antidepressants

May reduce the negative side effects of antidepressants (e.g. constipation)

Inexpensive treatment

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26
Q

Exercise and depression in adults greater in older or younger

A

older

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27
Q

Long-term effect of ET

A

small effect in favour of exercise

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28
Q

clear dose–response relationship overall?

A

no

Even infrequent participation in exercise (e.g. 1–2 days/week) is associated with reduced likelihood of depression

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29
Q

is ET able to decrease depressive symptoms in people with chronic disease

A

yes

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30
Q

Name gaps in the literature for chronic illness and ET.

3 (focused, few studies and no ? reviews)

A

1- focus on multi-component interventions but just ET
2- Few studies has assessed the relationship between exercise and depression in patients with asthma and type 2 diabetes (T2D)
3- No systematic reviews have examined specifically the role of aerobic exercise on depressive symptoms in NCDs

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31
Q

What was her thesis

A

Assess the efficacy of aerobic exercise on depressive symptoms in people living with a NCD compared to no treatment (i.e. usual care).

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32
Q

What was the type of study

A

Type of study: Systematic review and meta-analysis

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33
Q

What is a systematic review?

A

Literature review designed to synthesize all empirical evidence relating to a clearly formulated research question

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34
Q

What does a systematic review identify, appraises and summarizes?

A

Identifies relevant studies, appraises their quality and summarizes the evidence through explicit methodology

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35
Q

What kind of answers does a systematic review provide

A

Provides informative and evidence-based answers

36
Q

List the type of studies from low evidence to high 9

A 
1- background info
2- individual case reports
3- case series or studies
4- cohort
5- non randomized controlled trials
6- randomized controlled trials
7- critically appraised literature
8- systematic review
9- meta analysis
37
Q

8 procedure steps of systemic review

A 
1-Develop research question 
(Population, Intervention, Control, Outcome) 
2-Develop search strategy 
3-Contact research librarian 
4-Literature search
5-Data extraction
6-Data analysis
7-Interpretation of findings
8-Writing & editing for publication
38
Q

Define the PICOS of the study

A

P: Adults living with a NCD
I: Aerobic exercise intervention;
C: No exercise (usual care)
O: Reduction in depressive symptoms or depression

39
Q

What was the aerobic exercise intervention criteria.

Intensity and time

A

Moderate intensity (> 50% HRT), at least twice a week, 4 weeks

40
Q

Her main question was can aerobic…

A

Can an aerobic exercise intervention, compared to no exercise, reduce depressive symptoms in adults living with a NCD?

41
Q

Type of study what was the:
intervention
language
published date

A
  • randomized/non
  • english or french
  • studies published until june 29th 2017
42
Q

What was the chosen population

A

age above 18

living with NCD

43
Q

What was the intervention

A

aerobic exercise

44
Q

Name some data analysis methods that were used. 4

A

1- standardized difference in means
2- random effects model
3- funnel plot
4- Cochran’s Q and Higgings I2 test

45
Q

Subgroup analyses performed according to. 4

A

1- # days of training
2- duration of sessions
3- length of intervention
4- type of NCD

46
Q

standardized difference in means effect ranges

A

small: 0.2-0.5
med: 0.5 - 0.8
large: 0.8 and higher

47
Q

Results: how many participants and their age

A

4111 age 34-70

48
Q

Results intervention criteria:
frequency training
time of session
length of program

A

frequency: 2 and 5 sessions/week
Time: 20 and 80 mins
Length: 4 and 24 weeks

49
Q

What were the two limitations

A

1- lack of homogeneity across studies

2- Usual care may not have been similar across studies and NCDs

50
Q

What were the two strengths

A

1- Thorough search methods

2-Studies different on several levels (patient populations, quality…)

51
Q

lack of homogeneity was driven from what

A

driven by some large effect sizes and small sample sizes

52
Q

lack of homogeneity reduces what

A

Reduces clinical impact of findings

53
Q

Usual care may not have been similar across studies and NCDs. Attempts to reduce what

A

Attempt to reduce disparities using inclusion/exclusion criteria

54
Q

Studies different on several levels (patient populations, quality…) increases?

A

Increases generalizability of findings

55
Q

what was the conclusion

A

Overall, aerobic exercise more efficacious than usual care. Most efficacious in CVD

56
Q

are Length of intervention, number of days and duration key factors

A

no

57
Q

What are the NICE ET guidelines

A

45-60 minutes/session
3 sessions per week
12 weeks

58
Q

What are the potential mechanisms explaining a link between exercise and depression?

A

1- Physiological

2- psychological

59
Q

What are the 3 - Physiological hypothesis

A

1-Monoamine hypothesis
2-Inflammation hypothesis
3-Endorphin hypothesis

60
Q

Explain the monoamine hypothesis

A

Exercise increases the availability of brain neurotransmitters

61
Q

monoamine hypothesis studies are conducted on who

A

animals. unknown if applicable to human brain

62
Q

2-Inflammation hypothesis

A

Individuals with depression have elevated concentrations of pro-inflammatory biomarkers
Exercise has been shown to reduce these biomarkers.

63
Q

3-Endorphin hypothesis

A

Exercise leads to surge of endorphins

Reduce pain and provide state of euphoria

64
Q

Do endorphins directly alter mood state or indirectly facilitate improved mood through energy conservation during exercise

A

it is unclear

65
Q

Can euphoria state can be experienced at low level of intensity

A

yes

66
Q

Is High intensity level of exercise required to release endorphin

A

yes

67
Q

4- Psychological mechanisms

A

1-Distraction hypothesis
2-Self-efficacy theory
3-Mastery hypothesis
4-Social interaction

68
Q

1-Distraction hypothesis

A

Diversion from unpleasant stimuli or painful somatic complaints leads to improved affect following exercise

69
Q

Distraction hypothesis: support for long term effect?

A

no

70
Q

2-Self-Efficacy Theory

A

Level of confidence that one feels it possesses to meet the challenge at hand
Confidence in one’s ability to exercise is strongly related to one’s actual ability to perform the behavior

71
Q

Individual with high self-efficacy for exercise are more likely to exercise
yes or no

A

yes

72
Q

Mastery Hypothesis

A

Mere fact of exercising can make patients feel like they have achieved something

73
Q

Mastery Hypothesis mediator between

A

PE and QOL

74
Q

Social Interaction Theory

A

Social relationships and mutual support provided to one another by co-exercisers might account for antidepressant effects

75
Q

Social Interaction Theory results

A

mixed, Could be more important for older people

76
Q 
4 Limitations of current studies
1- gap in
2- lack of studies 
3- most studies do not
4- Most studies dont look at whether exercise can..
A

Gaps in litterature regarding long-term effects of exercise

Lack of studies looking at potential mechanisms

Most studies do not assess for clinical depression

Most studies do not look at whether exercise can treat clinical depression

77
Q

4 reasons why good quality research is lacking

A

1-Not always a distinction between PA and PE (except in intervention studies)

2- Few studies intent-to-treat

3-Not always including a control group

4-Usually targeting low/mild depression

78
Q

Overall conclusion about ET

A

it provides moderate benefits

79
Q

What exercise is a good treatment of mild to moderate depression

A

Both high & low-dose aerobic exercise

80
Q

True or False: Exercising 3 times per week is at least as effective as 5 times per week

A

true

81
Q

Exercise therapy should be done by what person

A

qualified professionals

82
Q

True or false: encourage exercise as an adjunct to other forms of therapy

A

true

83
Q

should FITT be common or individualized

A

individualized

84
Q

In future: RCTs should include 2 things

A

allocation concealment

Intent-to-treat analysis

85
Q

In future: studies should compare what

A

exercise and other alternative treatment to depression (e.g. music therapy)

86
Q

should there be a Systematic follow-up to see effect on long-term on depression and adherence to exercise

A

yes

EXCI 420-A (7 decks)

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